LODGING TAX APPLICATION-Visit Kitsap Peninsula-09.25.2023LODGING TAX APPLICATION (RCW 67.28.1816)
Instructions
For Budget Year:
2024
Available Funding Amount:
$100,000
Application Deadline: September 25, 2023, by 4:00
p.m.
Applicants may consist of convention and visitors’ bureaus, destination marking organizations, nonprofits,
including main street organizations, lodging associates, or chambers of commerce, and additionally the cities
or towns themselves.
Please read carefully and include all information. Omitting requested information could result in having your application
denied. Keep your answers clear, concise, and to the point of the question. Do not include presentation materials,
as these materials are more appropriate to be used as part of your oral presentation. Do not include brochures
or information not related to your project or request.
Submit completed signed application to the City Clerk’s office by the application deadline listed at the top of this
application. Applications will not be accepted if received after the application deadline.
Applicant Info
1. Applicant Information
Organization Name*
Visit Kitsap Peninsula
Street Address *
Street Address
9230 Bayshore Dr. NW
Address Line 2
Suite 101
City
Silverdale
State/Province/Region
WA
Postal/Zip Code
98383
Country
USA
Mailing Address (if different from street address)
Street Address
Address Line 2
City State/Province/Region
Postal/Zip Code Country
Type of Organization:*
Nonprofit Government Agency Other
Funding Requested for (choose one):*
Marketing and Operations of Events Tourism Marketing
Are you a first-time participant?*
Yes
No
2. Applicant Contact Information
Name*
Aljolynn Sperber
Position / Title*
Executive Director
Phone *
(310) 994-7383
Email Address*
aljolynn@visitkitsap.com
Event / Project Details
3. Overall Event or Project Detail
Project Name*
2024 Year-Round Tourism Marketing Support for the City of Port Orchard
Amount of funding requested*
$75,580.00
Total Overall Event or Project Amount*
$75,580.00
A. Describe your overall event or project.*
1) The Heartbeat Project: Celebrating Port Orchard's Local Businesses and Passions - The Heartbeat Project is a Poulsbo-based initiative aimed at promoting
48 local businesses per year and enticing tourists from a 50+ mile radius. Through engaging vertical videos on social media and informative blog posts for
SEO, we'll spotlight four businesses each month. Our goal is to support the local economy, encourage lodging bookings, and create a dynamic connection
between the community and visitors. With email marketing and potential expansion into podcasts and YouTube, The Heartbeat Project is set to breathe life
into Port Orchard, inviting travelers to experience the town's unique stories and fostering economic growth through their exploration.
2) Visitor Identification and Targeted Advertising in Port Orchard - The grant funds will be used to execute the "Visitor Identification and Targeted Advertising
in Poulsbo (2018-2024)" project. These funds will support media buying for digital and traditional advertising channels, acquisition of device detection and
web traffic monitoring technology, data analysis software, and comprehensive reporting mechanisms. Information will be distributed through digital
advertising, the official website, email marketing, press releases, and social media. Successes and results will be documented using key performance
indicators, regular reporting, an analytics dashboard, surveys, feedback, and comparisons to baseline data. The project aims to enhance visitor engagement
in Poulsbo and will employ data-driven strategies to achieve this goal.
3) Celebrating a Decade of Adventure: Kitsap Peninsula National Waterway Trails (KPNWT) 10-Year Anniversary - Visit Kitsap Peninsula (VKP) seeks a $20,000
grant from Port Orchard LTAC to celebrate the 10-year anniversary of Kitsap Peninsula National Waterway Trails in 2024. This project aims to promote Port
Orchard, emphasizing local water trails, attracting tourists for the summer. On June 8th, 2024, VKP plans a grand celebration. A $10,000 budget is allotted for
omni-channel marketing, spanning digital advertising, print media, social media engagement, email campaigns, and website optimization. Another $10,000
will support marketing operations, ensuring a seamless event with community engagement and safety measures. VKP aims to boost tourism, enhance
community involvement, and establish Port Orchard as a premier water trail destination.
B. Describe how your overall event or project will provide a community economic benefit.*
1) The Heartbeat Project will stimulate a community economic benefit by attracting tourists to Port Orchard. Increased patronage of local businesses, lodging
bookings, and enhanced sales revenue will invigorate the local economy, generating employment opportunities and sustaining the vitality of the town's
business community.
2) The targeted ads will boost the local economy by attracting more visitors to Port Orchard, resulting in increased tourism-related revenue. This includes
higher hotel bookings, restaurant patronage, and retail spending, creating job opportunities and generating tax revenue. The economic benefit will enhance
the overall prosperity and sustainability of the community.
3) The 10Y Anniversary of the KPNWT event will stimulate the local economy by attracting tourists to Port Orchard, generating increased revenue for local
businesses, hotels, and restaurants. The influx of visitors will lead to higher sales, job opportunities, and increased economic vitality, benefiting the entire
Port Orchard community.
C. Please describe how you will measure the impact your overall event or project will have on tourism or projected increase in
tourism. Please be specific and provide examples.*
1) The impact of The Heartbeat Project on tourism will be measured through a combination of quantitative and qualitative metrics. We will track:
- Lodging Bookings: By monitoring an increase in lodging bookings within Port Orchard during and after project promotion, we can directly measure the
project's impact on attracting tourists.
- Website Analytics: Utilizing tools like Google Analytics, we will measure website traffic, page views, and user engagement. An uptick in visits to the project's
website indicates growing interest in Port Orchard.
- Social Media Metrics: Tracking metrics like follower growth, likes, shares, and comments on social media platforms provides insights into audience
engagement and reach.
- Business Sales and Patronage: Surveys and data from featured local businesses will show whether the project positively influenced their sales and
patronage.
- Community Feedback: Qualitative data from community members and visitors, gathered through surveys or testimonials, will gauge the project's influence
on their perception of Port Orchard as a tourist destination.
Through these metrics, we can measure and quantify the tangible impact The Heartbeat Project has on tourism, demonstrating its effectiveness in attracting
visitors to Port Orchard.
2) Measuring the impact of the "Visitor Identification and Targeted Advertising in Poulsbo 2024" project involves a multi-faceted approach:
- Web Traffic and Engagement Metrics: Tracking website traffic, page views, bounce rates, and session durations reveals increased interest and engagement.
Higher conversion rates and click-through rates on digital ads signify improved tourism impact.
- Device Detection and Location Data: Real-time tracking of devices in Poulsbo's market area gauges immediate visitor influx and identifies regions where the
campaign successfully attracted visitors.
- Room Booking and Revenue: Monitoring room bookings and quantifying revenue generated directly demonstrates the project's contribution to the local
economy.
- Visitor Demographics and Surveys: Gathering qualitative insights through visitor surveys helps understand motivations. Analyzing demographic shifts pre-
and post-campaign highlights the target audience.
- Economic Impact Studies: Commissioned economic impact assessments measure job creation, increased business revenue, and tax revenue generated,
providing tangible economic benefits.
- Year-over-Year Comparisons: Comparing tourism statistics from 2018 to post-campaign years reveals the growth attributed to the project.
3) Measuring the 10Y Anniversary of the KPNWT - Visitor Data: We will track the number of attendees at the anniversary celebration and survey them to
determine their place of residence and the purpose of their visit. For instance, if we find a significant increase in attendees from cities like Seattle and Tacoma
who came specifically for the event, it indicates a positive impact on tourism.
- Lodging Bookings: By monitoring lodging bookings in Poulsbo during the summer of 2024 and comparing them to previous years, we can quantify the
event's effect on overnight stays.
- Web and Social Media Analytics: We will analyze website traffic, social media engagement, and the reach of our online campaign. Increased web visits and
engagement from our target regions will indicate heightened interest in Poulsbo as a tourist destination.
- Post-Event Surveys: Post-event surveys will collect feedback from attendees, including whether they plan to return to Poulsbo or recommend it to others,
providing qualitative insights into the event's impact.
By combining quantitative data with qualitative feedback, we can accurately assess the project's influence on tourism and its projected increase, helping us
make informed decisions for future initiatives.
Please upload any additional paperwork, if needed.
VISIT KITSAP PENINSULA - 2024 Port Orchard LTAC Presentation.pdf 7.97MB
Port Orchard 2022 Campaign Summary.pdf 823.43KB
SWT_W9_VKP.pdf 605.99KB
Visit Kitsap Peninsula Proof of Non-Proffit Status (1).pdf 250.92KB
Budget
4. Overall Event or Project Budget Summary
A. Describe, and be specific, on what you would spend the requested lodging tax funds on.*
1) The Heartbeat Project: $30,000 (TOTAL)
- $21,000.00 - Content Production and Promotion: Creating engaging videos, blog posts, and marketing materials, as well as boosting content on social media
and search engines.
- $6,000.00 - Project Operations: Administrative and project management expenses, ensuring smooth operation and reporting.
- $3,000.00 - Contingency: A reserve for unforeseen expenses or opportunities to enhance project impact, ensuring financial flexibility and project success.
2) Targeted Ads - $55,580.00 (TOTAL)
- Targeted Advertising - $36,000.00 ($3K per month)
- Ads Monitoring, Analyzing, and Managing - $7,700.00
- Datafy - Targeting Software - $2,880.00
- Creative Design - Quarterly Ad Creative Refresh - $9,000.00
3) 10Y KPNWT Anniversary - $20,000.00 (TOTAL)
- $10,000 for a targeted digital advertising campaign to promote the event and Port Orchard as a tourist destination. Ads will run from March 1 through June
7, 2024.
- $10,000 for marketing operations, including event planning, promotional materials, community engagement, and safety measures to ensure a successful
anniversary celebration.
B. Income Other Than Lodging Tax (from sponsorships, grants, donation and admission fees)
If you anticipate receiving partial funding for this activity from another source, please list the source(s) approximate amount, and status of funding.
Indicate the entry or admission fee if one will be charged.
Source*Amount*Confirmed or Projected?*
Kitsap LTAC $295,525.00 If projected, what is the anticipated receipt
date?
Projected
Poulsbo LTAC $40,000.00 If projected, what is the anticipated receipt
date?
Projected
Bremerton LTAC $50,000.00 If projected, what is the anticipated receipt
date?
Projected
Port of Bremerton $5,000.00 If projected, what is the anticipated receipt
date?
Confirmed
TOTAL*
(This is auto calculated from above)
$390,525.00
C. Other Expenses of Overall Event or Project (Only complete below boxes that are applicable to your overall event or project that you are seeking
funds for.)
Operations (postage, fuel, permit, etc.)Proposed City (LTAC) Funds Other Committed Funds Subtotals
$0.00
Event Marketing Proposed City (LTAC) Funds Other Committed Funds Subtotals
$0.00
Tourism Marketing Proposed City (LTAC) Funds Other Committed Funds Subtotals
$0.00
Other Activities (Please explain below)Proposed City (LTAC) Funds Other Committed Funds Subtotals
$0.00
Other Activities Explanation:
Proposed City (LTAC) Funds Subtotal Other Committed Funds Subtotal
$0.00 $0.00
TOTAL
$0.00
*City Lodging Tax funds would represent what percentage of your overall budget?
18
Can you operate this project with reduced funding?*
Yes (If Yes, Please explain below)
No
Explanation:
If your preference is to only work with us on one project, then we can do that. Or if you'd like to work with us on a revised scope of work; a lower-level of
engagement, then we can revise accordingly to help reach your lodging tax goals.
C. Other Financial Information
Does your overall event or project have provisions (or plans) for becoming less dependent on Lodging Tax funding? (Meaning does the
overall event or project have the ability to increase revenue by charging admission, increasing fees, etc.)*
1) The Heartbeat Project - We plan seek sponsorship funding and with audience growth and engagement develop merchandise for purchase
2) Targeted Ads - LTAC funding is the primary source for this
3) 10Y KPNWT Anniversary - Sponsorships, percentage of ticket sales, merchandise sold for the event
Visit Kitsap seeks grants and other sources of matching funds when opportunities arise. Proportionate to size and geography we have the least amount of
funding of any recognized DMO in the State of Washington. We also plan to work towards accessing TPA funds, though we need to go through a legislative
process with the State and need 80% of hotels to agree to adding TPA to their fees.
If not, what are your challenges of generating new revenues:
Tourism
5. Estimated Numbers of Increased Tourism
*If you received lodging tax funds last year, you must attach last year’s reporting*
Applicants applying for use of LTAC funds must provide estimates of how it will result in increases in the number of people traveling for business or
pleasure on a trip as required by RCW 67.28.1816
The applicant hereby certifies and confirms that it does not now nor will it during the performance of any contract resulting from this
proposal unlawfully discriminate against any employee, applicant for employment, client, customer, or other person(s) by reason of
race, ethnicity, color, religion, age, gender, national origin, or disability. That it will abide by all relevant local, state, and federal laws
and regulations. That it has read and understands the information contained in this application for funding and is in compliance with
the provisions thereof, and; that the individual signing below has the authority to certify to these provisions for the applicant
organization, and declares that he/she is an authorized official of the applicant organization, is authorized to make this application, is
authorized to commit the organization in financial matters, will assure that any funds received as a result of this application are used
for the purposes set forth herein, and verifies that all the information contained in this application is valid and true to the best of his/her
knowledge.
Projected*
Overall Attendance:
Attendees who traveled 50 miles or
more to attend:
Total:
Of total, attendees who traveled
from another state or country:
3,400
1,630
3,400
652
Previous Next
Attendees who stayed overnight:
Paid accommodations:
Unpaid accommodations:
Paid Lodging nights:
1,630
698
932
1,117
Signature*
Certified by:
Date*
09/25/2023
Print Name *
Aljolynn Sperber
Title*
Executive Director
2024 PORT ORCHARD LTAC
Let’s work together to amplify the Port Orchard community & increasehotel bookings!
VISIT KITSAP
PENINSULA
VKP is the official destination marketing
organization responsible for promoting the
Kitsap Peninsula region to attract and educate
travelers and planners that in turn generate
retail sales and tax revenues for businesses
and local, state and federal governments.
THE ECONOMIC IMPACT OF TOURISM
in taxes generated in Kitsap County
in revenue produced in Kitsap County
jobs supported within Kitsap County
largest industry in Washington State
$40M
$700M
8,000
4th
Source: Kitsap Economic Development Alliance
VISITORS IN PORT
ORCHARD IN 2023
Visitors to Port Orchard
stay an average of 1.6 days
and generally come from
our neighbor coastal
states.
VISITOR SPENDING
IN PORT ORCHARD
(2022 TO YTD 2023)
Visitor spending in
Port Orchard has
increased 11.2%,
which the largest
lift in July.
Outreach
Chambers, Hotels, Attractions, and
Government Officials
Host Reception
Recruit Board
Members & EDI
Committee
Host Board Retreat
Funding/Development
LTAC Applications
Hunt for “See you in Kitsap” & “Hidden Gems” & “Google My
Business” sponsors
Develop EDI
framework
Brand Refresh Website Re-Design & Re-Build Launch New Website
Campaigns
Plan Hidden Gems
Project Launch Hidden Gems Project: Interviews, Editing, and Publishing
Plan & Partner Outreach for “See you in Kitsap Campaign” Soft Launch “See you in Kitsap”
Official Launch of
“See you in Kitsap”
Evaluation
ARPA & LTAC
Reporting
Monthly Report to
Stakeholders
Monthly Report to
Stakeholders
Monthly Report to
Stakeholders
Monthly Report to
Stakeholders
Monthly Report to
Stakeholders
Monthly Report to
Stakeholders
Monthly Report to
Stakeholders
Monthly Report to
Stakeholders
2023 2024
September October November December January February March April
Goal: Announce new VKP ED
appointment Goal: Recruit diverse board Goal: Host board retreat + secure
sponsorship
Goal: Secure partners for 2024
campaigns
Goal: Secure funding for
campaigns
Goal: 80% completed w/ website
re-design & re-build
Goal: 1,000 interactions w/
campaign soft launch
Goal: Successful website and
campaign launches
6-Month VKP Roadmap
10Y Anniversary of Kitsap
Peninsula National Water Trails Designed For: Designed by: Date: Version:
Key Partners
Cost Structure Revenue Stream
Key Activities
Key Resources Channel
Value
Propositions
Customer
Relationship
Customer
Segments
Local Businesses: Partner
with local hotels,
restaurants, and water
activity providers for
collaborative promotions
and offers.
Local Government
Partner DMOs
Event Planners
Local Chambers
KEDA
Local Press
Visit Kitsap Aljolynn Sperber
Lite Event Planning: Organizing the
grand celebration on June 8th,
2024.
Marketing Campaign Execution
Community Engagement
Content Creation
Marketing Costs: Expenses for digital advertising, print media, social media
management, and email campaigns.
Event Expenses: Costs for venue, decorations, entertainment, and safety
measures.
Personnel Costs: Salaries and wages for the marketing and event teams.
Technology Costs: Investments in website optimization and online tools.
Partnership Costs: Collaborative expenses with partners.
Marketing Team
Event Planners
Technology Infrastructure
Financial Resources
Printed Materials
Tourism Income: Attract tourists to Poulsbo who spend on accommodations,
dining, and activities.
Event Ticket Sales: Sell tickets for the grand celebration.
Sponsorships: Attract sponsors for the event and marketing initiatives.
Merchandise Sales: Offer event-themed merchandise for purchase.
Donations: Accept donations from community members and well-wishers.
Tourist Experience: Kitsap
Peninsula as a premier
water trail destination.
Community Involvement
Safe and Memorable Event
Collaborative Marketing
Regional Promotion
Customer Engagement
Community Involvement
Customer Support
Feedback Loop
Digital Advertising
Print Media
Social Media
Email Campaigns
Website Optimization
Tourists: Visitors interested
in water trails, outdoor
activities, and local culture.
Local Community:
Residents of Poulsbo and
neighboring areas.
Sponsors: Businesses and
organizations looking for
promotional opportunities.
Government Bodies: Local
government entities and
committees.
109/25/23
The Heartbeat Project (Podcast)Designed For: Designed by: Date: Version:
Key Partners
Cost Structure Revenue Stream
Key Activities
Key Resources Channel
Value
Propositions
Customer
Relationship
Customer
Segments
Visit Kitsap Aljolynn Sperber
Local Businesses: Those
seeking promotion.
Tourists/Visitors:
Individuals interested in
visiting Kitsap.
Sponsors/Advertisers:
Companies looking to
reach your audience.
109/25/23
Local Businesses: Build strong, mutually
beneficial partnerships.
Tourists/Visitors: Engage with them on social
media, through email campaigns, and
potentially through podcasts or YouTube.
Sponsors/Advertisers: Maintain good
relationships to secure ongoing
partnerships.
Social media platforms (Facebook,
Instagram, potentially YouTube).
Website & Blog
Email marketing campaigns.
Local tourism websites and
directories.
Podcast platforms.
Promotion for Local
Businesses: Offering exposure
to local businesses.
Tourist Attraction: Attracting
tourists to the area.
Community Engagement:
Fostering a stronger
connection between the
community and visitors.
Unique Content: Providing
engaging and informative
content.
Economic Growth: Contributing
to the economic growth of
Kitsap.
Lodging Bookings: Earn a commission or referral fee for lodging bookings driven by your
project.
Sponsorship and Advertising: Revenue from sponsors and advertisers for podcasts and
YouTube content.
Collaboration Fees: Local businesses may pay a fee to be featured in your project.
Merchandise Sales: If you have branded merchandise related to Kitsap or your project.
Donations/Subscriptions: Potentially, if you offer premium content or seek donations from your
audience.
Content Creation
Marketing Expenses: Advertising on social media platforms, email marketing costs.
Website Maintenance: Hosting and maintenance of your online presence.
Potential Podcast/YouTube Costs: Equipment, hosting fees, and production costs if
you expand into these mediums.
Podcast host(s)
Marketing Tools
Website/Blog
Funding
Local Business Relationships
Content Creation
Business Outreach
Social Media Management
Email Marketing
Analytics and Feedback
Sponsorship and Advertising.
Local Businesses
Lodging Facilities
Podcast Hosts/Producers
Sponsors/Advertisers
Local Chamber
Kitsap Economic
Development Alliance
Targeted Digital Ads (50+ miles)Designed For: Designed by: Date: Version:
Key Partners
Cost Structure Revenue Stream
Key Activities
Key Resources Channel
Value
Propositions
Customer
Relationship Customer
Segments
Local businesses and
lodging establishments in
Kitsap.
Advertising agencies for
media buying and
campaign execution.
Technology providers for
device detection and web
traffic monitoring.
Data analysis software
vendors; i.e. Datafy and
website analytics.
Survey and feedback
platforms.
Visit Kitsap Aljolynn Sperber
Media buying across digital and
traditional advertising channels.
Data analysis to identify visitor trends
and preferences.
Content creation for digital
advertising, website, email marketing
Regular reporting and analytics
dashboard management.
Media buying costs.
Technology acquisition and maintenance expenses.
Staff salaries and training.
Content creation and marketing expenses.
Survey and feedback collection costs.
Reporting and analytics tools - Datafy & Ad Reporting
Skilled marketing and data analysis
teams.
Technology infrastructure for
monitoring and analysis.
Access to digital advertising
platforms.
Survey tools and data analysis
software.
Increased tourism revenue for local businesses.
Potential revenue from partnerships and sponsorships.
Grants and funding from Lodging Tax Committees.
Enhanced visitor
engagement and increased
tourism.
Data-driven strategies for
effective advertising.
Improved ROI on
advertising spend for local
businesses.
Comprehensive reporting
and insights for
stakeholders.
A more attractive and
vibrant Kitsap for residents
and tourists.
Collaborative relationships with
local businesses.
Ongoing communication with
Lodging Tax Committees.
Engagement with visitors through
digital channels.
Timely responses to feedback and
surveys.
Digital Advertising Platforms
Official Website
Email Marketing
Press Releases
Social Media
Trip Advisor & Other Trip &
Travel-Related Platforms
Local businesses in Kitsap
seeking increased tourism.
Lodging Tax Committees
looking to invest in tourism
promotion.
Visitors to Kitsap interested in
local attractions and
experiences.
Residents of Kitsap interested
in promoting the local
economy.
Targeting prospective visitors that
live 50+ miles away, and
international.
109/25/23
2024 INITIATIVES
Website re-build and re-design to be more user-friendly,
responsive, and can modernize for today’s travelers who are
mobile - We’re looking 10 years out people, not just for
today :)
Re-work wireframe for responsiveness
Work with tech leaders in our community to track visitors
and modernize for voice assistant, augmented reality,
utilize AI for personalized recommendations, and
accessible for wearable devices such as smartwatches
ADA compliant
Available in multiple languages - will base it on affinity
shown in our website analytics
Brand refresh that is modern and timeless, and stands out
Curated itineraries tailored to specific interests
Clear insights through Datafy, with ability to reach visitors
directly
Increased PR efforts to target, attract and host travel writers and
influencers from across the globe
10ᵗʰ anniversary celebration of KPNWT
Launch a narrative and experience-focused campaign titled
“See you in Kitsap” that will leverage storytelling, technology,
and omni-channel marketing
VISION SUMMARY
As I work on the vision, I am asking myself “how will people access information in the next 10 years?”
and “how do we make Kitsap the #1 destination in the PNW in 2024?” I and VKP cannot answer these
questions alone, so we invite you to join us on this journey.
Let’s help people across the world see themselves in Kitsap, visit Kitsap, and share their stories and
experience about Kitsap with their friends, family, and community.
Visit Kitsap Peninsula is a catalyst for economic vitality, job creation, and community pride.
Want to work together in this mission? Email Aljolynn Sperber at aljolynn@visitkitsap.com
06/03/22 - 2/11/23
1,835,242 3,398
$14,0001,835,242 3,398
0.19%$7.63
119,883
SUBSTITUTE
W-9
State of Washington TourismP.O. Box 16612, Seattle, WA 98111
Phone: 509.945.3026
Request for Taxpayer Identification Number and Certification
►Go to www.irs.gov/FormW9 for instructions and the latest information.
PART I Taxpayer Information (TYPE or PRINT LEGIBLY)
1 Name (as shown on your income tax return). Name is required on this line; DO NOT LEAVE BLANK.
See PART III Which Name, Number and Tax Classification to Give the Requestor for additional guidance.
2 Business Name / Doing Business As (DBA) name / disregarded entity name, if different from above.
3 Check appropriate box for federal tax classification of the name entered on line, CHECK ONLY ONE.
See PART III Which Name, Number and Tax Classification to Give the Requestor for additional guidance.
Individual C-Corporation Single-member Limited Liability Company (LLC)*
Sole Proprietor S-Corporation LLC – Partnership
Trust/Estate Nonprofit Corporation LLC – C-Corporation
Public Entity/Government Partnership LLC – S-Corporation
*NOTE: DO NOT check this box if single-member LLC is owned by another entity and disregarded for tax purposes. Select the tax classification of
the owner entity name on Line 1.
4 Address (number, street, and apt or suite no.). 5 City, State, and ZIP Code
PART II Taxpayer Identification Number (TIN) ENTER ONLY ONE TIN
Enter your TIN in the appropriate box to the right. The TIN provided must match the name given on Line 1 to avoid backup withholding. For individuals and sole proprietors this is generally your
social security number (SSN). For single-member LLC/disregarded entity, see PART III Which
Name, Number and Tax Classification to Give the Requestor for additional guidance. For most
other entities, it is your employer identification number (EIN).
NOTE: See PART III Which Name, Number and Tax Classification to Give the Requestor for
additional guidance.
Social Security Number (SSN)
- -
or
Employer identification number (EIN)
-
PART III Which Name, Number and Tax Classification to Give the Requestor
IF the payee is a(n)… THEN enter name on Line 1 for…
THEN check the tax
classification on
Line 3…
THEN enter TIN in
PART II…
1.Individual
The individual
* Two or more individuals (joint account), list both names and circle
the name of the person whose SSN you furnish
Individual SSN
2.Sole Proprietor The individual owner
(business name or DBA goes on Line 2) Sole Proprietor SSN
3.Trust/Estate The legal entity
* If Revocable Trust, the individual grantor-trustee Trust/Estate EIN
* if Revocable Trust, SSN
4.Public Entity / Government The public entity, such as a state or local government, school
district
Public Entity /
Government EIN
5.C-Corporation, orS-Corporation, or
Nonprofit Corporation
The corporation
C-Corporation, or
S-Corporation, or
Nonprofit Corporation
EIN
6.Partnership The partnership Partnership EIN
7.Single-member Limited
Liability Company (LLC)
If owned by an individual, and disregarded for tax purposes:
The individual owner (disregarded LLC name goes on Line 2)
Single-member Limited
Liability Company
(LLC)
SSN, or
EIN of individual owner
(NOT the LLC)
*IRS prefers SSN
If owned by an entity, and disregarded for tax purposes:
The owner entity name (disregarded LLC name goes on Line 2) of the owner entity EIN
8.LLC - Partnership The LLC partnership LLC - Partnership EIN
9.LLC - C-Corporation, or
LLC - S-Corporation The LLC corporation LLC - C-Corporation, or
LLC - S-Corporation EIN
PART IV Signature and Certification
Under penalties of perjury, I hereby certify that: 1) the above information is true and correct, 2) I am not subject to backup withholding, and 3) I am a U.S.
person (including a U.S. resident alien).
Sign
Here Signature of
U.S. person Date